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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1354212

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Case Details

VAERS ID: 1354212 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram abnormal, Extrasystoles, Heart rate increased, Heart rate irregular
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 04/15/2021 EKG, Blood work. It did show on the EKG.
CDC Split Type: vsafe

Write-up: 04/13/2021 Began having irregular heart beat, lasted for 3 hours. 04/15/2021 Began having irregular heart beat again, extra and skipped beats. This continued all night. Visited ER It finally subsided on the evening of 04/16/2021


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